“As this stems from fairly new research, many clinics do not perform these tests or take them that seriously—but I am so grateful that I was tested, as I clearly didn’t have a healthy environment to carry a baby!” Charlotte now reflects. “Who knows how long this had been going on in my body? It could have been the cause of my previous failed transfers. This is the one test I now tell everyone I know struggling to do, just to rule it out.”
Is it worth it?
“I’ve never seen any randomized placebo-controlled double line crossover studies that show that doing this test and addressing whatever’s in the test—by taking probiotics, for example—actually makes a difference in the live birth rates of people going through fertility treatment,” begins Dr. Chen. “Having said that, I do think we need to understand the vaginal microbiome more in order to optimize our health. It’s a real thing.” She says she’ll give this test to patients who request it—after she explains that the test is invasive, expensive (around $300), and not covered by insurance—but isn’t convinced it’s necessary: “There’s simply not enough data yet to support the idea that this testing is helpful in terms of direct treatment for infertility. It’s in the same category as the Receptiva test, but it gives you even less data.”
Dr. Aimee, on the other hand, has recommended the tests to her patients—but it’s not always a first priority. “For my patients, I’m always thinking about the uterine microbiome, but not necessarily the vaginal microbiome because I can test the uterine microbiome directly,” she says. “That said, when I do an endometrial biopsy for the Receptiva test, I also send some cells to Igenomix, the company that provides the EMMA and ALICE test. Or, if my patients have an unfit uterine lining and they’ve already done an endometrial biopsy in the past and don’t want to do it again, then I’ll recommend one of these vaginal microbiome tests to them.”
Test #6: Hysterosalpingogram (HSG)
What it is:
A hysterosalpingogram is a painful X-ray procedure in which a patient’s uterus and fallopian tubes get filled with dye to see whether the fallopian tubes are open. The test also shows the size and shape of your uterus, and the presence of scarring or adhesions.
A patient backstory:
Forty-year-old Lindsay H., who spent 10 years doing fertility treatments on and off and now has two children, says her first gynecologist told her not to bother with the HSG test since her blood tests had come back fine at the time. “Looking back now, I wonder how extensive those tests were, because four years later, I saw another ob-gyn who ordered fertility tests—and those showed I had low ovarian reserve,” she reflects. “That doctor recommended an HSG, but I was afraid of the pain and my insurance wasn’t going to cover the cost, so I researched an alternative option called Femvue, which was similar but used air bubbles instead of dye. I went to a specialist to have this done and the results showed that my tubes were open, and not blocked.” But two years later, after an unsuccessful IUI and IVF attempt, Lindsay’s next fertility doctor required the HSG. She took it, and it showed her right tube was blocked and had to be removed before she completed the next round of IVF. “If I had only done this test six years prior, I would have saved so much time, frustration, and money!” she reflects.
Is it worth it?
This is usually part of the standard infertility work-up, but not always—though the doctors I spoke to say it should be. “HSG should always be done at the very beginning of fertility treatment,” advises Dr. Chen. “I’ve seen people being treated for years, taking all of the drugs, and then they come to find out their tubes were blocked because nobody had ever looked at the inside of their uterus or determined if their tubes were open.” If the test shows that your tubes are indeed damaged or blocked, then you’ll know you need to take the next steps to fix them. This can involve a hysteroscopy (a procedure that allows a doctor to look inside the uterus using a thin tube called a hysteroscope and can address intrauterine abnormalities like fibroids, polyps, or scar tissue), or a procedure that targets the fallopian tubes, like a laparoscopy or even tubal reconstructive surgery or removing one or both tubes entirely, like Gueren did (though this is less common).
